- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.57 / $2,562.00 / $4,050.00
| Facility | | $328.57 | $2,562.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $132.16 / $132.16 / $200.80
| Facility | 52 | $132.16 | $132.16 | $200.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $0.03
| Facility | | $0.02 | $0.03 | $0.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,309.00 / $7,168.00
| Facility | | $385.00 | $1,309.00 | $7,168.00 |